Provider Demographics
NPI:1386714939
Name:WHITE, STEPHEN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:WHITE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 GARFIELD RD N
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5003
Mailing Address - Country:US
Mailing Address - Phone:231-946-1903
Mailing Address - Fax:231-946-1951
Practice Address - Street 1:2781 GARFIELD RD N
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5003
Practice Address - Country:US
Practice Address - Phone:231-946-1903
Practice Address - Fax:231-946-1951
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1080276Medicaid
MI1080276Medicaid